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Publications and Forms

EDI Project Agreement (WC-EDI-210)

A form for self-insured, self-administered employers, insurance companies or third-party administrators regarding electronic data interchanges (EDI) project agreement.

EDI Receivers Specifications (WC-EDI-256)

A Missouri electronic transmission profile receiver's specifications.

EDI Secure File Transfer Protocol (FTP) (WC-EDI-207)

Information regarding the secure file transfer protocol (FTP) for the transmission of electronic data interchange (EDI) transactions.

EDI Sender Trading Partner Profile (WC-EDI-261)

A sender's trading partner profile.

EDI Sender Trading Partner Profile - List of Insurers (WC-EDI-260)

A list of insurers for a sender's trading partner profile.

EDI Senders Response (WC-EDI-257)

A transmission profile- sender's response.

Electronic File Specifications and Record Layout for ACH Credit Payments (MODES-4799)

This booklet contains instructions and file specifications for electronic payments via ACH Credit to the Missouri Division of Employment Security.

Electronic Fund Transfer Enrollment Form (WC-132)

This form must be used by the Workers' Compensation Insurance Carriers, the Self-Insured Employers and the Self-Insured Groups or trusts who would like to make Second Injury Fund surcharge payments to the Missouri Division of Workers' Compensation through an Electronic Fund Transfer.

Employee's Application for Religious Exception (WC-138)

The form to be completed by an employee request to be exempt from workers' compensation due to religious reasons.

Employee's Religious Exception Affidavit and Waiver (WC-138-3)

The affidavit to be completed by an employee request to be exempt from workers' compensation due to religious reasons.

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